Diagnosis of Autism in an Ethnical Diverse, Community Sample: who refers and why?

Maria Valicenti-McDermott, M.D.,M.S., Rosa Seijo,M.D., Lisa Shulman , M.D.

Children’s Evaluation and Rehabilitation Center at Montefiore, Rose F Kennedy Center, Albert Einstein College of Medicine, Bronx, NY
RESULTS
Maria.valicenti-mcdermott@einstein.yu.edu
We identified 502 children. Information on source of referrals and main concern was
available in 350 Main concerns included: rule out
OBJECTIVES
autism in 131 (34%),
BACKGROUND 1)To examine referral source and chief Table 1: Demographics Characteristics for Children by Referral Source
language problems in 98 (26%) and
Children with Autism concern for referrals for children Demographic characteristics Parents Pediatrician Other pa
N=157 N=117 N=76 behavioral problems in 43 (11%).
Spectrum Disorder (ASD) diagnosed with ASD in an ethnically Age at diagnosis (mo± SD) 42 ± 16 37 ± 14 41± 15 0.004
benefit from early diagnosis diverse, community setting; Diagnosed before age 3 n(%) 62 (39%) 64(54%) 32(42%) 0.001
and intervention services. 2)to assess the association between Gender Male/Female 132(85%)/25(16%) 90(77%)/27(23%) 58(76%)/18(24%) 0.9
Use of Medicaid n(%) 60 (39%) 28 (24%) 26(36%) 0.03 a: non
Efforts to increase early referral source with demographics and
Ethnicity n(%) N=153 N=112 N=76 0.1c parametrics;
identification have been clinical presentation. Hispanic 76 (49%) 57 (51%) 39(51%) b: t-test;
directed at pediatricians, White 21 (13%) 14 (12%) 11(14%)
`chi-square
Black 42 (27%) 29 (26%) 15(20%)
including the DESIGN/METHODS Other 14 (9%) 12 (10%) 11(14%)
recommendation from the Review of all children initially Level Maternal Education n(%) N=112 N=97 N=60 0.1
American Academy of diagnosed with ASD from 2003 to 2012
Less than High School 15 (12%) 17 (17%) 11 (18%)
CONCLUSION: In this ethnically
HS graduate/GED 28 (33%) 20 (21%) 13(22%)
Pediatrics for ASD screening age 1 to 6, in a University Affiliated Some College 33 (27%) 38 (39%) 13(22%) diverse population, parent referral
in 2007, as well as parents Developmental Center. College Graduate/Masters 45 (36%) 22 (22%) 23(38%)
accounted for the majority of
like the CDC initiative “Learn Data included:
Mother born in the US n(%) 76 (59%) 62 (61%) 30(54%) 0.3
Bilingual Household n(%) 25 (16%) 21 (18%) 28 (37%) 0.6 children, but young children (under
the Signs, Act Early”. •age, Family history of autism n(%) 50 (16%) 36 (22%) 14 (18%) 0.1
Early diagnosis of ASD has 3 years) were more likely to be
•demographics, Patient born before 2005 77 (49%) 37 (31%) 35 (46%) 0.001
referred by physician.
become an important clinical •year of referral
and public health goal. Children who were born before the
•referral source,
Information obtained in 2007 AAP recommendation for
•main concerns, Table 2: Main Concerns and Child Clinical Characteristics by Referral Source
ethnically diverse populations pediatric universal screening were
•autistic features (based on DSM-IV-TR Clinical characteristics Parents Pediatrician Other pa
is critical, as children who are and Childhood Autism Rating Scale) more likely to be older, and to be
N=157 N=117 N=76
Latino or African American and Concerns about Autism 57 (46%) 42 (41%) 16 (30%) 0.1 referred for evaluation by their
are already being diagnosed •cognitive level. Concerns about Language Delays 55 (37%) 57 (50%) 22 (33%) 0.04 parents. In recent years, there is
later, families may be less To examine year of referral, we also Language Regression n(%) 33(21%) 30 (26%) 16 (21%) 0.8 an increase in referrals from
aware of ASD symptoms or divided children in two groups and
Toe Walking n(%) 38 (24%) 49 (42%) 23 (31%) 0.008
pediatricians, and children referred
less likely to bring them to the Non Verbal cognitive >70 n(%) 54 (51%) 42 (59%) 29 (55%) 0.6
compared data, between those Seizures n(%) 5 (3%) 5 (4%) 4 (5%) 0.4 presenting milder autistic features.
attention of their healthcare children born before 2005, before Vineland ABC(mean±SD) 67 ± 12 66 ± 13 68 ± 11 0.7b Since 2007, children are being
providers. pediatric universal screening CARS total score (mean±SD) 34 ± 6 35 ± 5 35 ± 7 0.3b diagnosed earlier. Efforts to
It is intriguing in an ethnically recommendations, and those born in
diverse, community setting, increase early identification should
2005 or later, who would have been of continue.
how children with ASD come age to undergo ASD screening by 24
to attention, what is the main Born Before 2005 During or after 2005 p~
months based on the 2007 AAP N=295 N=217
concern and who refers them recommendation. Age at Diagnosis (mo±SD) 44± 15 31 ±11 <0.001
for developmental evaluation Statistics included chi-square, t-test Referred by Pediatrician 37 (33%)/112 80 (50%)/160 0.005
and non parametrics, and logistic Non Verbal cognitive >70 n(%) 72 (35%)/206 95 (67%)/142 <0.001
Vineland ABC(mean±SD) 64 ± 11 71 ± 10 <0.001b
regression CARS total score (mean±SD) 36 ± 6 34 ± 5 0.008b